Setting national standards for practice equipment. Presence of equipment in Estonian practices before and after introduction of guidelines with feedback.
BACKGROUND
During the last few years quality assurance has received increasing attention in Estonian health care as well as in family medicine, which is a new speciality in Estonia (since 1993). The modest equipment that district doctors (former primary care doctors) had at their disposal, appeared inadequate considering family doctors' work tasks.


OBJECTIVE
To determine the type of equipment available in primary care practices before setting a standard, and 1 year after the minimal standard of practice equipment was introduced. To follow how well family doctors adhere to this standard.


METHODS
A questionnaire was sent to a random sample of district doctors (n=157) in 1992 and to all family doctors practising as independent contractors in 1998 (n=376). Quality of equipping was assessed against the standard set by consensus of the representatives of Family Doctors' Society, based on the country's needs and family doctor's job description.


RESULTS
The level of primary care doctors' office equipment in 1992 was quite low. However, by the spring of 1998, substantial improvement of the equipment in family doctors' practices was estimated. The number of doctors possessing instruments for otorhinolaryngological, ophthalmological and gynaecological work as well as for taking care of children had increased two- to three-fold. About one-half of the family doctors reported that they had all the instruments listed in the standard.


CONCLUSIONS
Setting a national standard helps to improve practice equipment--an important structural aspect of quality of care. Although improvement of equipment alone cannot guarantee quality of care, it may provide an important first step towards promoting it.
Kalda
R
R
Department of Polyclinic and Family Medicine, University of Tartu, Estonia. ruthk@cut.ee
Lember
M
M
D003625:Data Collection; D004864:Equipment and Supplies / Q000592:standards*; D004957:Estonia; D005194:Family Practice; D005246:Feedback; D019983:Guideline Adherence; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011786:Quality Control