Grol R, Wensing M
Centre for Quality of Care Research of the University of Nijmegen, Netherlands.
Br J Gen Pract. 1995 Oct;45(399):548-52.
The introduction of quality assurance and medical audit has been an important development in general practice. However, the introduction of such programmes does not necessarily mean they are implemented by general practitioners.
A study was undertaken to describe the problems and requirements perceived by general practitioners in relation to the implementation of quality assurance and medical audit in general practice.
Interviews were carried out with a stratified sample of 120 Dutch general practitioners. Knowledge, acceptance and application of quality assurance and medical audit activities were investigated, and perceived problems and requirements in implementing quality assurance and audit activities were explored.
General practitioners in the Netherlands were generally positive towards quality assurance activities, but had little experience of carrying out such activities. The most frequently mentioned obstacles to implementing quality assurance activities concerned lack of time, colleagues' negative attitudes and fear of assessment and criticism by colleagues. Requirements for implementing quality assurance included having regular meetings with colleagues about quality assurance, having information on the aims and methods of quality assurance, having data from other practices with which to compare performance, having support in data collection, in audit in the practice and in setting up local peer review, and having financial support. The most important factor predicting the actual application of quality assurance activities was found to be knowledge of specific quality assurance activities.
Well-designed programmes for the implementation of quality assurance and medical audit, using a variety of different interventions, have to be developed. Such programmes should include the training of professionals in the concepts and methods of quality assurance as well as the provision of financial support for quality assurance activities.
质量保证和医学审计的引入是全科医疗中的一项重要发展。然而，此类项目的引入并不一定意味着它们会由全科医生来实施。
开展一项研究，以描述全科医生在全科医疗中实施质量保证和医学审计方面所察觉到的问题和需求。
对120名荷兰全科医生进行分层抽样访谈。调查了质量保证和医学审计活动的知识、接受程度及应用情况，并探讨了实施质量保证和审计活动中察觉到的问题和需求。
荷兰的全科医生总体上对质量保证活动持积极态度，但开展此类活动的经验较少。实施质量保证活动最常提到的障碍包括时间不足、同事的消极态度以及担心受到同事的评估和批评。实施质量保证的要求包括与同事定期召开关于质量保证的会议、获取有关质量保证目标和方法的信息、拥有其他诊所的绩效比较数据、在数据收集、诊所审计及建立本地同行评审方面获得支持，以及获得资金支持。发现预测质量保证活动实际应用的最重要因素是对特定质量保证活动的了解。
必须制定精心设计的质量保证和医学审计实施方案，采用多种不同的干预措施。此类方案应包括对专业人员进行质量保证概念和方法的培训，以及为质量保证活动提供资金支持。
