[Evaluation of a primary care self-management project].

OBJECTIVE

To evaluate a "Primary Care Self-Management Project" started in 1992.

DESIGN

An observational and semi-experimental study with sub-designs: post-test, pretest/post-test with one group, pre-test/post-test with a non-equivalent control group and multiple temporal series.

SETTING

An urban area.

PARTICIPANTS

The nine Primary Care teams (PCT) in Vitoria-Gasteiz.

INTERVENTION

A decentralised budget for self-management was assigned to each PCT, which included Chapter I, staff replacements and Chapter II, Stores, Laboratory, Radiology and Maintenance.

MEASUREMENTS AND MAIN RESULTS

1. Cost control and adjustment of each PCT to the assigned budget. There was an overall saving of 1.8% of the total decentralised budget (96,959,988 pesetas). Six of the nine PCTs fulfilled their assigned budgets. 2. The increase in professional motivation was partially measured by looking at short-term spells off work in the Absence from Work index. In the PCT this index fell 31% from 1991 to 1992, from 4.2 to 2.9%. Among the County's other staff this index remained practically stable, falling only from 5.1 to 4.8%. 3. Higher productivity and better budget use was measured by looking at replacement costs, which went down 7.2% from 1991 to 1992. The proportion of cost arising from replacements for scheduled activities went from 57.9% in 1991 to 39.1% in 1992.

CONCLUSIONS

Self-management, at least within the scope of this study, has positive effects on various aspects of the PCTs' work.