Kringos Dionne Sofia, Boerma Wienke, Pellny Martina
NIVEL - Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Qual Prim Care. 2009;17(3):165-77.
This World Health Organization (WHO) study aimed to develop and field test an instrument to assess the availability of structures and mechanisms for managing quality in primary care in countries in transition.
The instrument is based on a literature study, consensus meetings with experts, and observations in these countries. It consists of three parts: a semi-structured questionnaire on national policies and mechanisms; a structured questionnaire for general practitioners (GPs); and a structured questionnaire for use with managers of primary care facilities. The instrument has been field tested in 2007 in Slovenia and Uzbekistan.
In Slovenia, leadership on quality improvement was weak and local managers reported few incentives and resources to control quality. There was a lack of external support for quality improvement activities. Availability and use of clinical guidelines for GPs were not optimal. GPs found teamwork and communication with patients inadequate. In Uzbekistan, primary care quality and standards in health centres were extensively regulated and laid down in numerous manuals, instructions and other documents. Managers, however, indicated the need for more financial and non-financial levers for quality improvement and they wanted to know more about modern healthcare management. GPs reported strong involvement in activities such as peer review and clinical audit, and reported frequent use of clinical guidelines. Overall, the information gathered with the provisional instrument has resulted in policy recommendations. At the same time, the pilot resulted in improvements to the instrument.
Application of the instrument helps decision makers to identify improvement areas in the infrastructure for managing the quality of primary care.
世界卫生组织（WHO）的这项研究旨在开发并实地测试一种工具，以评估转型期国家初级保健质量管理制度与机制的可利用情况。
该工具基于文献研究、与专家的共识会议以及在这些国家的观察结果。它由三部分组成：一份关于国家政策和机制的半结构化问卷；一份针对全科医生（GPs）的结构化问卷；以及一份供初级保健机构管理人员使用的结构化问卷。该工具于2007年在斯洛文尼亚和乌兹别克斯坦进行了实地测试。
在斯洛文尼亚，质量改进方面的领导力薄弱，当地管理人员表示控制质量的激励措施和资源很少。质量改进活动缺乏外部支持。全科医生临床指南的可得性和使用情况并不理想。全科医生发现团队合作以及与患者的沟通不足。在乌兹别克斯坦，卫生中心的初级保健质量和标准受到广泛规范，并在众多手册、说明和其他文件中有所规定。然而，管理人员表示需要更多用于质量改进的财务和非财务手段，并且他们希望更多地了解现代医疗管理。全科医生报告称积极参与同行评审和临床审计等活动，并经常使用临床指南。总体而言，通过该临时工具收集的信息已形成政策建议。同时，试点工作对该工具进行了改进。
该工具的应用有助于决策者确定初级保健质量管理基础设施中的改进领域。
