General practice covers a large and complex field. It is neither realistic nor desirable to propose indicators for all tasks. It is not feasible to describe all aspects of practice by means of key figures.
The quality of practice, however, is not universally definable. Quality should be assessed with regard to clinical performance, to patient satisfaction and to cost-benefit considerations. These points of view may at times contradict, and different judgements of values may lead to differing conclusions .
Even in the absence of a general definition, it remains important to judge quality. The reflection over quality in practice is itself a quality criterion.
This use of indicators is one of several methods for the evaluation of practice. The SATS project provides a few examples of different ways of applying the method.
The project group chose topics with the intent of covering general aspects of practice.
1. Diabetes care: The theme illustrates the organisation of care for patients with chronic disease. National guidelines of recent date exist for the condition, which has a 2 % prevalence in the population at large.
2. The acute sore throat: The theme sheds light on the basis for the prescription of antibiotics in acute infectious disease.
3. The use of laboratory tests: In an international perspective, the use of laboratory tests in general practice seems high in Norway. The topic bears upon the organisation of practice, and the importance of history and clinical examination as grounds for doctors' actions. The theme involves the auxiliary staff in practice. Indicators are recorded along with a broad report of the analyses used, as compared with the consultation rate and age distribution in the practice.
4. Migraine: The topic is of current interest with the recent introduction of government reimbursement of sumatriptane prescriptions. Health authorities have attached criteria to these regulations which may be linked to indicators of quality. The individual practitioner will thus be thus able to monitor his own compliance to both quality criteria and official requirements. Also, focus is set on the use of opiates in the management of the condition.
The quality of reports will depend on systematic and precise record information. The project may thus enhance interest in record quality in general.
The ICPC code has hitherto had its main role in reimbursement routines between practitioners and social security authorities. The project encourages focus on the professional importance of this tool.
The project evaluation will assess the response of the practitioners to the new method. The reports of indicator measurements will enable a conclusion as to whether the method produces quality improvement. The diabetes intervention will be compared with a control project without specific intervention.
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Department of Public Health and Primary Health Care, last updated 09.05.96
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