IMPLEMENTATION OF QUALITY ASSURANCE AND MEDICAL AUDIT - GENERAL-PRACTITIONERS PERCEIVED OBSTACLES AND REQUIREMENTS

Background. The introduction of quality assurance and medical audit ha s been an important development in general practice. However, the intr oduction of such programmes does not necessarily mean they are impleme nted by general practitioners. Aim. A study was undertaken to describe the problems and requirements perceived by general practitioners in r elation to the implementation of qualify assurance and medical audit i n general practice. Method Interviews were carried out with a stratifi ed sample of 120 Dutch general practitioners. Knowledge, acceptance an d application of quality assurance and medical audit activities were i nvestigated, and perceived problems and requirements in implementing q uality assurance and audit activities were explored.Results. General p ractitioners in the Netherlands were generally positive towards qualit y assurance activities, but had little experience of carrying out such activities. The most frequently mentioned obstacles to implementing q uality assurance activities concerned lack of time, colleagues' negati ve attitudes and fear of assessment and criticism by colleagues. Requi rements for implementing quality assurance included having regular mee tings with colleagues about quality assurance, having information on t he aims and methods of quality assurance, having data from other pract ices with which to compare performance, having support in data collect ion, in audit in the practice and in setting up local peer review, and having financial support. The most important factor predicting the ac tual application of quality assurance activities was found to be knowl edge of specific quality assurance activities. Conclusion. Well-design ed programmes for the implementation of quality assurance and medical audit, using a variety of different interventions, have to be develope d. Such programmes should include the training of professionals in the concepts and methods of quality assurance as well as the provision of financial support for quality assurance activities.