Measuring mechanisms for quality assurance in primary care systems in transition: test of a new instrument in Slovenia and Uzbekistan.
BACKGROUND
This World Health Organization (WHO) study aimed to develop and field test an instrument to assess the availability of structures and mechanisms for managing quality in primary care in countries in transition.


METHODS
The instrument is based on a literature study, consensus meetings with experts, and observations in these countries. It consists of three parts: a semi-structured questionnaire on national policies and mechanisms; a structured questionnaire for general practitioners (GPs); and a structured questionnaire for use with managers of primary care facilities. The instrument has been field tested in 2007 in Slovenia and Uzbekistan.


RESULTS
In Slovenia, leadership on quality improvement was weak and local managers reported few incentives and resources to control quality. There was a lack of external support for quality improvement activities. Availability and use of clinical guidelines for GPs were not optimal. GPs found teamwork and communication with patients inadequate. In Uzbekistan, primary care quality and standards in health centres were extensively regulated and laid down in numerous manuals, instructions and other documents. Managers, however, indicated the need for more financial and non-financial levers for quality improvement and they wanted to know more about modern healthcare management. GPs reported strong involvement in activities such as peer review and clinical audit, and reported frequent use of clinical guidelines. Overall, the information gathered with the provisional instrument has resulted in policy recommendations. At the same time, the pilot resulted in improvements to the instrument.


CONCLUSIONS
Application of the instrument helps decision makers to identify improvement areas in the infrastructure for managing the quality of primary care.
Kringos
Dionne Sofia
DS
NIVEL - Netherlands Institute for Health Services Research, Utrecht, The Netherlands. d.kringos@nivel.nl
Boerma
Wienke
W
Pellny
Martina
M
D003906:Developing Countries; D014943:Global Health; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D010821:Physicians, Family / Q000458:organization & administration; D010865:Pilot Projects; D011320:Primary Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D012107:Research Design; D017524:Slovenia; D014610:Uzbekistan; D014944:World Health Organization / Q000458:organization & administration