title: Improving access to primary care: the impact of a quality-improvement strategy.
abstract: OBJECTIVE
  Many patients are not satisfied with the accessibility and availability of general practice, and they would like to see improvement.
  
  
  METHODS
  Quality-improvement study with pre-intervention and post-intervention data collection in 36 general practices.
  
  
  METHODS
  General practices located in the south of The Netherlands.
  
  
  METHODS
  Patient satisfaction, experiences and awareness; practice information; and experiences of a mystery patient.
  
  
  METHODS
  The practices received feedback about their accessibility and availability compared with data from practices of colleagues. The practices developed practice-based improvement plans using these feedback results.
  
  
  RESULTS
  Eighty per cent of the improvement plans were completed or almost completed in 5 months. After the intervention, the accessibility by phone within 2 min increased significantly (10% improvement). The practices that designed an improvement plan showed a larger increase (25% improvement) than practices that did not. Patient awareness of an information leaflet and a separate telephone number for emergency calls also significantly increased (29% improvement and 12% improvement) in practices that designed improvement plans.
  
  
  CONCLUSIONS
  Feedback and practice-based improvement plans were a stimulus to work on and to improve accessibility and availability. All practices started improvement plans, but the overall effect of the changes was modest. This may be due to acceptable accessibility and availability before the intervention was introduced and to the time period of 5 months, which seemed to be too short to complete all practice-based improvement plans. The mystery patient was more satisfied with the accessibility than the real patients. This may be related to our concept of accessibility. We learned that adding a mystery patient for data collection can contribute to more objective measurements of practice accessibility than patient questionnaires alone.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, 6525 EZ Nijmegen, The Netherlands. k.kirschner@iq.umcn.nl
authors.forename: Kirsten
authors.initials: K
authors.lastname: Kirschner
authors.forename: J
authors.initials: J
authors.lastname: Braspenning
authors.forename: I
authors.initials: I
authors.lastname: Maassen
authors.forename: A
authors.initials: A
authors.lastname: Bonte
authors.forename: J
authors.initials: J
authors.lastname: Burgers
authors.forename: R
authors.initials: R
authors.lastname: Grol
mesh_terms: D005246:Feedback; D058006:General Practice / Q000592:standards*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement