Quality of care: the need for medical, contextual and policy evidence in primary care

Journal of Evaluation in Clinical Practice - Tập 11 Số 5 - Trang 417-429 - 2005
Mieke L van Driel1, An IM De Sutter1, Thierry Christiaens2, Jan M. De Maeseneer3
1Researcher, Department of General Practice and Primary Health Care, Ghent University, Belgium
2Professor of general practice, Department of General Practice and Primary Health Care, Ghent University, Belgium
3Professor of general practice, head of department, Department of General Practice and Primary Health Care, Ghent University, Belgium

Tóm tắt

AbstractThe increasing availability of medical evidence in clinical practice was expected to improve the quality of care. However, this has not been realized. A possible explanation is that quality of care is a complex concept and needs a wider scope. Starting from the Donabedian triangle of structure, process and outcome, a framework for the analysis of quality of care is presented. The need for three types of evidence is identified and discussed: medical, contextual and policy evidence. Although the body of medical evidence is increasing, it has major flaws and gaps hampering its applicability in primary care. There is also a need to focus on the context of the medical encounter, which has been shown to influence outcome, but is still not well researched. Finally, evidence on costs, cost utility and equity needs to be considered. Taking these different aspects of evidence into account, an agenda for research in primary care is set. The analytical framework may provide new insights in the quest for improving quality of health care.

Từ khóa


Tài liệu tham khảo

10.7326/0003-4819-140-5-200403020-00013

10.1136/bmj.326.7386.417

10.1136/bmj.317.7156.465

10.1001/jama.1995.03530240045039

10.1056/NEJM200005183422024

Britten N., 2000, Misunderstandings in prescribing decisions in general practice: qualitative study, British Medical Journal, 320, 484, 10.1136/bmj.320.7233.484

10.1136/bmj.317.7159.637

10.1001/jama.282.15.1458

Centers for Disease Control and Prevention (CDC, 2003, Public health and aging: health‐related quality of life among low‐income persons aged 45–64 years – United States, 1995–2001, Morbidity and Mortality Weekly Report, 52, 1120

10.1016/S0277-9536(96)00221-3

10.1001/jama.287.5.612

Christiaens T.C.M., 2002, Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women, British Journal of General Practice, 52, 729

Cochrane Library(2004)Issue 2http://www.cochrane.org

10.1136/bmj.310.6977.452

10.1093/fampra/18.4.359

10.1370/afm.148

10.1016/S0140-6736(03)14576-X

10.1007/BF02284954

De Sutter A.I., 2002, Does amoxicillin improve outcomes in patients with purulent rhinorrhea? A pragmatic randomized double‐blind controlled trial in family practice, Journal of Family Practice, 51, 317

10.1093/fampra/18.2.209

10.1016/S0738-3991(02)00017-4

10.1136/bmj.325.7362.472

10.1056/NEJM197906143002402

10.1016/S0140-6736(00)04169-6

10.1001/jama.1988.03410120089033

10.3109/13814780109048776

Van Driel M., 2003, Evidence‐based medicine versus evidence‐based policy: family medicine in the frontline, European Journal of General Practice, 9, 124

Effective Health Care, 1999, Getting evidence into practice, Effective Health Care Bulletin, 5, 1

Elwyn G., 1999, Shared decision‐making in primary care: the neglected second half of the consultation, British Journal of General Practice, 49, 477

10.1016/S0140-6736(98)02268-5

10.1136/bmj.317.7171.1496

10.1136/bmj.319.7220.1294

10.1136/bmj.322.7286.567

10.1056/NEJM200106283442611

10.3310/hta8060

10.1016/S0140-6736(03)14546-1

10.1046/j.1365-2753.2003.00382.x

10.1136/bmj.324.7349.1287

10.1097/00005650-198903001-00010

10.1136/bmj.324.7335.477

10.1001/jama.279.6.440

10.1001/archinte.163.1.49

10.1136/bmj.323.7318.908

10.1136/bmj.314.7082.722

Lohr K.M., 1990, Medicare: A Strategy for Quality Assurance

10.1016/S0140-6736(98)09102-8

10.1016/S0140-6736(96)05153-7

10.1136/bmj.316.7149.1922

10.1046/j.1365-2753.2003.00438.x

Mold J., 1991, Goal‐oriented medical care, Family Medicine, 23, 46

10.1136/bmj.326.7379.45

10.1136/bmj.328.7435.303-a

NIVEL(2004)http://www.nivel.nl/peilstations/index.shtml(accessed 9 July 2004).

10.1093/fampra/6.3.188

10.1016/0277-9536(94)00155-M

10.7326/0003-4819-137-2-200207160-00007

10.1016/S0140-6736(98)90295-1

10.1136/bmj.314.7079.525

RIZIV [Belgian National Health Insurance Institute] Jaarverslag(2003) Available fromhttp://inami.fgov.be/presentation/nl/annual‐report/2003/ar2003‐nl.htm(accessed 9 July 2004).

Sackett D.L., 2002, Evidence‐Based Medicine. How to Practice and Teach EBM

10.3122/jabfm.16.5.412

10.1016/S0140-6736(05)78475-0

Sunaert P., 1998, Inclusie, exclusie en uitval in relatie tot demografische en sociale economische kenmerken. [Inclusion, exclusion and drop‐out in relation to demographic and socio‐economic characteristics], Huisarts en Wetenschap, 41, 193

10.1007/BF03082652

10.1016/S0140-6736(04)16080-7

10.1016/S0895-4356(97)00306-5

Van der Velden J., 1998, Sociale verschillen in morbiditeit en verrichtingen in de huisartspraktijk. [Social differences in morbidity and performance in general practice], Huisarts en Wetenschap, 41, 165

10.3109/13814789609161652

10.1016/S0140-6736(00)04176-3

10.1037/0022-006X.44.4.580

10.1056/NEJM196111022651805

10.1016/S0140-6736(04)16043-1

10.3109/13814780309160399

Willems S., 2004, Oxford Textbook of Primary Medical Care, 161

World Health Organisation(2004)World Health Report 2004. Changing History.Available fromhttp://www.who.International/whr/2004/en/(accessed 9 July 2004).

Thông tin
Thông tin xuất bản

Journal of Evaluation in Clinical Practice

Tập 11 Số 5

417-429

Thông tin tác giả