Quality assurance in primary medical care.

Some general ideas of the evaluation of the work of the physician applicable also to primary care physicians are taken up in this article. The presentation is not trying to be a complete review of the topic. It tries, however, to direct attention to the importance of the subject from the point of view of the practising physician and also to point out some ideas of the possible difficulties to be faced in connection with primary medical care. Certain basic weaknesses of the original audit method in the primary setting are indicated. The usefulness of the structure-process-outcome model and of the understanding of the complex interactions and relationships between the various components of this model are stressed. Finally, a couple of promising methods relating to the work of the primary care physician are described. From the practice point of view the basic problem is to decide to what extent either the process or outcome are valid indicators of quality. Here one should keep in mind that correlation between these two measurements may be low and that it has been expressed by some (1) that, fundamentally, validity depends on the strength of the relationship between process and outcome and on our understanding of that relationship.