216 Use of good practice indicators by the College of General Practitioners of East Paris

Autor: Dupagne Dominique, Guy Jean-Louis, Atlan Pierre, Pigneur Jacques, Wohrer Philippe
Rok vydání: 2010
Předmět:
Zdroj: BMJ Quality & Safety. 19:A130-A131
ISSN: 2044-5423
2044-5415
DOI: 10.1136/qshc.2010.041624.84
Popis: Background and objectives The CGEP (French acronym for the College of General Practitioners of East Paris) is an independent association with no funding from industry which has been certified by HAS (French National Authority for Health) and CNFMC (National Councils for Continuous Medical Education). Its members are private and salaried general practitioners. The objective of CGEP is to improve health by improving care through the use of good practice indicators (GPI). The focus is on practice improvement (the aim) rather than on practice assessment per se (the tool). Programme This was a 3-year programme initiated in 2007, run by the association9s committee, and with 29 participating GPs. The programme involves an analysis of practice and sharing of experience by GPs on chosen GPIs for common diseases (in particular iatrogenic disease, sleep disturbances, orders for tests, diabetes, and hypertension). The GPI criteria were reliability of the recommendations (ie, no conflict of interest with the health care industry), their relevance to professional practice, and feasibility within the scope of general practice. These criteria are potential guarantors of health improvements through guideline implementation. Practice analysis and sharing of experience occurred twice at a 6 to 12 months interval. Participants received guides on each indicator for practice analysis. They were able to make qualitative and quantitative comparisons of their own practice over time and also compare their practice with that of their peers at different times. The indicators were also used to measure trends in practice for the whole group. Results No participant dropped out suggesting that the initiative was relevant and feasible. There was a positive trend towards compliance with guideline recommendations by almost all participants and especially by the group as a whole (eg, for orders for tests, diabetes, child obesity). For example, group compliance showed increases: from 37% to 86% of patient files for the GPI ‘no a non steroidal anti-inflammatory drug during pregnancy’ (iatrogenic disease during pregnancy); from 33% to 79% for the GPI ‘advice on the correct use of condoms’ (sexually transmitted infections); from 37% to 56% for the GPI ‘prescription of alternatives to benzodiazepines’ (sleep disturbances). Although compliance is a surrogate endpoint for determining clinical impact, it is nevertheless essential. Discussion and conclusion Relevant and reliable GPIs are essential. Without them, there is no practice improvement plan and consequently no managed clinical improvement. However, GPIs are few and far between despite work done by HAS and the first-rate journal Prescrire. CGEP plans to turn the present initiative into a permanent project but its scope of action is seriously hampered by administrative ‘beating about the bush’ and by mandatory participation of GPs in various schemes (CME/PPA/CDP). The participation of specialists and allied health professionals, besides GPs, would probably be an asset. We plan to invite interested specialists, pharmacists, nurses and other allied health professionals to join us in the management of common diseases in order to put the patient back at the centre of the action. Le College des Generalistes de l9Est Parisien, association 1901 strictement independante de tout financement industriel, est un organisme agree (HAS et CNFMC). Le CGEP regroupe des medecins generalistes liberaux et salaries. L9objectif du CGEP est l9amelioration de la sante par l9amelioration des soins reposant sur des indicateurs de bonne pratique (IBP). Le CGEP a prefere le terme d9Amelioration des pratiques professionnelles (APP) au terme d9EPP qui constitue un outil et non une finalite. Programme Ce programme a ete mis en place en 2007. Il se deroule sur 3 ans. 29 professionnels, generalistes liberaux et salaries, y sont inscrits. Il repose sur une analyse de la pratique couplee a un echange de pratiques entre professionnels concernant des indicateurs choisis dans les pathologies frequentes (notamment Pathologies iatrogenes, Troubles du sommeil, Prescription d9examens complementaires, Diabete, HTA). Le programme est mis en œuvre par les membres du bureau de l9association. Les criteres des indicateurs de bonne pratique selectionnes par le groupe EPP-CGEP sont: fiabilite (recommandations indemnes de conflits d9interets avec l9industrie de la sante), pertinence (par rapport a la pratique des professionnels), faisabilite (dans le cadre de l9exercice professionnel), garantes de leur mise en œuvre en vue de l9amelioration de sante de la population en charge. L9analyse et l9echange des pratiques se fait 2 fois, espacees de 6 a 12 mois. Les participants recoivent des ‘aide-memoire’ concernant chacun des indicateurs sur lesquels a porte leur analyse de pratique. Les participants peuvent ainsi, qualitativement et quantitativement, comparer l9evolution de leur propre pratique et comparer leur pratique a celle de leurs pairs a plusieurs mois de distance. Il existe enfin une dimension collective: l9evolution globale de la pratique du groupe est mesuree a l9aune des indicateurs choisis. Resultats Les resultats sont positifs. Nous constatons: une adhesion des inscrits au projet, sans defection, rendant compte de sa pertinence et de sa faisabilite le CGEP estime que l9amelioration objectivee des pratiques professionnelles est un critere certes intermediaire mais essentiel d9amelioration de l9impact clinique. A ce titre, les resultats, bien que non homogenes, sont encourageants. Nous constatons une evolution positive dans le sens des recommandations, de la quasi-totalite des participants et surtout du groupe dans son ensemble. Quelques exemples (outre prescription d9examens complementaires ou diabete ou obesite infantile): pour la pathologie iatrogene au cours de la grossesse (Indicateur: pas d9AINS durant la grossesse) le groupe est passe de 37% seulement de demarches de BP a 86% de dossiers concordants avec l9IBP. pour les InfectionsSexuellementTransmissibles (Indicateur: conseils d9utilisation correcte des preservatifs) de 33% a 79% d9application de BP. pour la prescription dans les troubles du sommeil (IBP: alternatives aux BZD) le groupe est passe de 37% a 56% de demarches cliniques en accord avec l9IBP. Discussion Indicateurs de bonne pratique: c9est le socle de notre action: Sans IBP pertinents et fiables, pas de programme d9APP et pas d9amelioration clinique organisee. Or, le nombre d9indicateurs valides et pertinents reste insuffisant malgre les travaux de la HAS et de la revue Prescrire dont nous sommes proches. Action continue: Le programme est prevu pour devenir permanent et non pas ponctuel. Les tergiversations administratives concernant l9obligation effective de la FMC/EPP/DPC constituent un frein notable a l9action du CGEP. Polydisciplinarite autour du patient. La participation de specialistes et de professionnels de sante, autres que les seuls medecins generalistes serait sans doute un plus pour notre programme d9APP. Notre projet est d9integrer les autres specialites interessees, autour de pathologies frequentes, ainsi que pharmaciens, infirmieres et autres paramedicaux, afin de replacer le patient au centre de notre action.
Databáze: OpenAIRE
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