Improving interprofessional collaboration in primary care: position paper of the European Forum for Primary Care.

Primary care is the central pillar of health care. The increasingly complex health needs of the population and individual patients in a changing society can only be met by promoting interprofessional collaboration (IpC) within primary care teams. The aim of this Position Paper of the European Forum for Primary Care (EFPC) is to analyse how to improve IpC within primary care teams. Clarification of the concept is the first step. Conditions to improve IpC are based on the education of healthcare professionals, adapting human resources, the occupational structure and the skill-mix in primary care. These conditions, dependent on contextual factors, have a major influence on the development of IpC. They can be developed and organised at different levels: national, regional or team level. A framework is also needed to evaluate the level of collaboration within teams. Examples of good practice throughout Europe issued from the EFPC network illustrate this.

Dealing with uncertainty in general practice: an essential skill for the general practitioner.

Many patients attending general practice do not have an obvious diagnosis at presentation. Skills to deal with uncertainty are particularly important in general practice as undifferentiated and unorganised problems are a common challenge for general practitioners (GPs). This paper describes the management of uncertainty as an essential skill which should be included in educational programmes for both trainee and established GPs. Philosophers, psychologists and sociologists use different approaches to the conceptualisation of managing uncertainty. The literature on dealing with uncertainty focuses largely on identifying relevant evidence and decision making. Existing models of the consultation should be improved in order to understand consultations involving uncertainty. An alternative approach focusing on shared decision making and understanding the consultation from the patient's perspective is suggested. A good doctor-patient relationship is vital, creating trust and mutual respect, developed over time with good communication skills. Evidence-based medicine should be used, including discussion of probabilities where available. Trainers need to be aware of their own use of heuristics as they act as role models for trainees. Expression of feelings by trainees should be encouraged and acknowledged by trainers as a useful tool in dealing with uncertainty. Skills to deal with uncertainty should be regarded as quality improvement tools and included in educational programmes involving both trainee and established GPs.

Testing a European set of indicators for the evaluation of the management of primary care practices.

BACKGROUND: Effective practice management is an important prerequisite for offering good clinical care. Internationally valid, reliable and feasible indicators and instruments are needed to describe and compare the management of primary care practices in Europe. OBJECTIVE: This paper describes development and evaluation of the European Practice Assessment instrument and indicators (Engels Y, Campbell S, Dautzenberg M et al. Developing a framework of, and quality indicators for, general practice management in Europe. Fam Pract 2005; 22(2): 215-22). METHODS: The study design was a validation and feasibility study set in 273 general practices in Austria, Belgium, France, Germany, Israel, The Netherlands, Slovenia, Switzerland and the UK. Use was made of a set of 62 valid quality indicators derived previously from an international Delphi procedure. The EPA instrument, based on this set of indicators, was used to collect data in the 273 practices. This instrument consists of self-completed questionnaires for doctors, staff managers and patients. In addition, there is an interview schedule for use by an outreach visitor, to be held with the lead GP or manager, and a visitor checklist. The instrument was analysed using expert review by the project partners, factor and reliability analyses, ANOVA analyses and by determining intraclass correlations. RESULTS: Fifty-seven indicators were found to be valid, feasible, reliable and discriminative in all participating countries. The instrument was able to determine differences in practice management within and between countries. All (but one) practices completed the assessment procedure. The data collection method appeared to be feasible, although some aspects can be improved. CONCLUSION: The EPA instrument provides feedback to practices that facilitates quality improvement and can compare primary care practices on a national and an international level.