ASSESSMENT OF MANAGEMENT IN GENERAL-PRACTICE - VALIDATION OF A PRACTICE VISIT METHOD

Background. Practice management (PM) in general practice is as yet ill -defined; a systematic description of its domain, as well as a valid m ethod to assess it, are necessary for research and assessment. Aim. To develop and validate a method to assess PM of general practitioners ( GPs) and practices. Method. Relevant and potentially discriminating in dicators were selected from a systematic framework of 2410 elements of PM to be used in an assessment method (VIP = visit instrument PM). Th e method was first tested in a pilot study and, after revision, was ev aluated in order to select discriminating indicators and to determine validity of dimensions (factor and reliability analysis, linear regres sion). Results. One hundred and ten GPs were assessed with the practic e visit method using 249 indicators; 208 of these discriminated suffic iently at practice level or at GP level. Factor analysis resulted in 3 4 dimensions and in a taxonomy of PM. Dimensions and indicators showed marked variation between GPs and practices. Training practices scored higher on five dimensions; single-handed and dispensing practices sco red lower on delegated tasks, but higher on accessibility and availabi lity. Conclusion. A visit method to assess PM has been developed and i ts validity studied systematically. The taxonomy and dimensions of PM were in line with other classifications. Selection of a balanced numbe r of useful and relevant indicators was nevertheless difficult. The di mensions could discriminate between groups of GPs and practices, estab lishing the value of the method for assessment. The VIP method could b e an important contribution to the introduction of continuous quality improvement in the profession.