Improving access to primary care: the impact of a quality-improvement strategy.

Abstract

PROBLEM: Many patients are not satisfied with the accessibility and availability of general practice, and they would like to see improvement. DESIGN: Quality-improvement study with pre-intervention and post-intervention data collection in 36 general practices. SETTING: General practices located in the south of The Netherlands. KEY MEASURES FOR IMPROVEMENT: Patient satisfaction, experiences and awareness; practice information; and experiences of a mystery patient. STRATEGY FOR CHANGE: 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. EFFECTS OF CHANGE: 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. LESSONS LEARNED: 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.