The desire to be a better doctor versus the lack of time and resources; Promotors and inhibitors for quality improvement work in general practice. A qualitative analysis of 2715 free-text replies from participants in a quality improvement project.

Torunn Bjerve Eide, Nicolas Øyane, Sigurd Høye

Keywords: Quality improvement. Continuous Medical Education. Antibiotic prescribing.

Background:
Continuous quality improvement (QI) is necessary to maintain and develop high quality general practice services. GPs´ motivation is an important factor to understand the success of QI initiatives. There is an increasing strain on GPs´ time and responsibilities (6), and we need more knowledge concerning GPs reactions to participation in QI projects to help initiate and implement further QI work.

Research questions:
Which factors contribute to impair or promote GPs´ motivation for and participation in QI projects?

Method:
We used questionnaire data from the QI project "Correct Antibiotic Use in the Municipalities", a combined electronic and face-to-face course consisting of three GP peer group meetings over 9 months. Each GP individually completed e-learning modules, and the content was discussed in the subsequent meetings. The participants received reports detailing their individual antibiotic prescriptions for a defined period, including a comparison with the corresponding period during the previous year. We analysed 2715 free text answers from 2208 GPs using text-driven inductive thematic analysis.

Results:
We identified three overarching themes in the GPs´ thoughts on inhibitors and promotors of QI work: 1) The desire to be a better doctor 2) Practical and structural factors as both promotors and inhibitors, and 3) Properties related to different QI measures. The participants stressed the importance of a safe peer group for discussions. The motivating effect of involving the whole GP practice in QI work was underlined. QI tools should be easily available and directly relevant in clinical work. The provision of individual prescription data was generally very well received.

Conclusions:
The desire to be good doctor is a strong motivator, but the framework for general practice must allow for QI initiatives. QI tools must be easily obtainable and relevant for practice. Initiatives to facilitate QI work may be more successful if they target the GP practice instead of the individual GP.

Points for discussion:
1. How can different organisational models for general practice promote or inhibit QI work?

2. How can health authorities help GPs to improve quality of practice?