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Published on: February 16, 2011
General practitioners' views on quality markers for children in UK primary care: a qualitative study
Peter J Gill1, Jenny Hislop, David Mant
1Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, UK. peter.gill@phc.ox.ac.uk
Insights
General practitioners (GPs) in the UK support developing quality markers for child healthcare. However, challenges remain in creating measurable, targeted standards within primary care control.
Area of Science:
- Pediatric Primary Care
- Healthcare Quality Improvement
- General Practice Research
Background:
- Children constitute 20% of the UK population, yet their healthcare is underrepresented in the UK Quality Outcomes Framework.
- Less than 3% of current quality markers pertain to pediatric care, highlighting a significant gap.
Purpose of the Study:
- To investigate general practitioners' (GPs) views on introducing child-specific quality markers in UK primary care.
- To explore potential areas and challenges for developing quality indicators in pediatric general practice.
Main Methods:
- A qualitative interview study was conducted with 20 GPs across four primary care trusts in Thames Valley, England.
- Semi-structured interviews explored GPs' perspectives on quality markers and relevant childhood conditions.
- Thematic analysis using a constant comparative method was employed for data interpretation.
Main Results:
- All interviewed GPs supported the creation of benchmarks to enhance child healthcare quality.
- No consensus emerged on specific clinical conditions for quality markers; concerns about unmet needs and proactive care were raised.
- GPs expressed powerlessness regarding outcomes outside their control (e.g., emergency visits) and emphasized the importance of access to timely appointments and specialist support.
Conclusions:
- GPs are in favor of developing quality markers for pediatric care in UK general practice.
- Key challenges include ensuring markers are measurable, targeted, and within primary care's direct influence.
- Improving access to primary and secondary care appointments may serve as a crucial benchmark for healthcare commissioners.
Background:
Children make up about 20% of the UK population and caring for them is an important part of a general practitioner's (GP's) workload. However, the UK Quality Outcomes Framework (pay-for-performance system) largely ignores children - less than 3% of the quality markers relate to them. As no previous research has investigated whether GPs would support or oppose the introduction of child-specific quality markers, we sought their views on this important question.
Methods:
Qualitative interview study with 20 GPs from four primary care trusts in Thames Valley, England. Semi-structured interviews explored GPs' viewpoints on quality markers and childhood conditions that could be developed into markers in general practice. Interviews were audiotaped and transcribed verbatim. Analysis was thematic and used constant comparative method to look for anticipated and emergent themes as the analysis progressed.
Results:
All the GPs interviewed supported the development of 'benchmarks' or 'standards' to measure and improve quality of care for children. However no consensus was expressed about the clinical conditions for which quality markers should be developed. Many participants reflected on their concerns about unmet health care needs and felt there may be opportunities to improve proactive care in 'at risk' groups. Some expressed feelings of powerlessness that important child-relevant outcomes such as emergency department visits and emergency admissions were out of their control and more directly related to public health, school and parents/carers. The importance of access was a recurrent theme; access to urgent general practice appointments for children and GP access to specialists when needed.
Conclusion:
The GPs expressed support for the development of quality markers for the care of children in UK general practice. However, they flagged up a number of important challenges which need to be addressed if markers are to be developed that are measureable, targeted and within the direct control of primary care. Easy access to primary and secondary care appointments may be an important benchmark for commissioners of care.
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