title: Quality improvement in primary care: ethical issues explored.
abstract: OBJECTIVE
  Quality improvement (QI) processes in family medicine are becoming increasingly complex. Their influence on the organisation of the sector and on the daily work processes is profound and increasing. The literature indicates that many ethical issues are arising from QI work. Therefore this paper aims to identify the experiences of professionals involved in planning and performing QI programmes in European family medicine on the ethical implications involved in those processes.
  
  
  METHODS
  Four focus groups were carried out with 29 general practitioners (GPs) and administrators of general practice quality work in Europe. Two focus groups comprised EQuiP members and two focus groups comprised attendees to an invitational conference on QI in family medicine held by EQuiP in Barcelona in November 2006.
  
  
  RESULTS
  Four overarching themes were identified, including implications of using patient data, prioritising QI projects, issues surrounding the ethical approval dilemma and the impact of QI. Each theme was accompanied by an identified solution.
  
  
  CONCLUSIONS
  Prioritising is necessary and in doing that GPs should ensure that a variety of work is conducted so that some patient groups are not neglected. Transparency and flexibility on various levels is necessary to avoid harmful consequences of QI in terms of bureaucratisation, increased workload and burnout on part of the GP and harmful effects on the doctor-patient relationship. There is a need to address the system of approval for national QI programmes and QI projects utilising more sophisticated methodologies.
  
  
  CONCLUSIONS
  This study provides data from GPs who are experienced quality improvers across 17 countries. Many ethical issues were identified and it was possible to clearly map the themes and their relationships and to summarise the identified solutions from an international perspective.
authors.affiliation: Centre for Health Sciences Research, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Tapp
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.forename: Søren
authors.initials: S
authors.lastname: Holm
authors.forename: Tina
authors.initials: T
authors.lastname: Eriksson
mesh_terms: D003219:Confidentiality / Q000941:ethics; D005260:Female; D006291:Health Policy; D006801:Humans; D038622:Internationality; D008297:Male; D011320:Primary Health Care / Q000941:ethics* / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000941:ethics* / Q000458:organization & administration*; D011787:Quality of Health Care / Q000941:ethics / Q000458:organization & administration