External quality assessment of general practice laboratories: organizational issues and interpretation of feedback reports.
OBJECTIVE
To describe and evaluate organizational issues and handling of feedback reports in the Norwegian external quality assessment scheme (EQAS) for general practice laboratories.


METHODS
Postal questionnaire survey including three EQAS feedback reports (one with acceptable analytical quality, one indicating a problem with precision and one indicating bias of the measurement method) to 535 randomly selected general practices.


RESULTS
The response rate was 80%. Two-thirds of practices were group practices, and 16% of practices employed a medical technologist. Nearly all practices found the manual for analysing quality control material easy to understand, and samples seemed to be handled as part of routine laboratory work. Feedback reports were primarily studied by those responsible for laboratory work in the practice, and only in 60% of practices by doctors. Practice routines for follow-up of deviant results in the EQAS seemed to have been established. Internal quality control was performed in 90% of group practices and in 71% of solo practices. Concerning responses to feedback reports, there seemed to be a substantial need for assistance even for less deviant results, although most actions suggested by the practices were adequate. On the other hand, assistance was not always sought for "critical" problems.


CONCLUSIONS
EQAS is feasible in primary care, but instructions must be clear and conclusions in the feedback reports made very explicit. Easy-to-reach assistance from medical technologists with expertise in general practice laboratory instruments and routines seems paramount.
Thue
G
G
NOKLUS, Department of Public Health and Primary Health Care, University of Bergen, Norway. geir.thue@isf.uib.no
Klovning
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A
Sandberg
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D005194:Family Practice / Q000458:organization & administration*; D005246:Feedback; D007753:Laboratories / Q000592:standards*; D009664:Norway; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires