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Continuing Professional Development Integration of Formal CME and Quality Improvement Initiatives
Basic elements of integration of elements of QI in CPD	Previous    Contents    Next

Patient and community priorities concerning health care should be central to CPD – activities

QI initiatives can start from health problems detected by the community or individual patients. Quality Improvement methods use patient evaluation programmes. Guidelines can include patient perceptions. Patient empowerment can lead to improvement of care (Box 1).

Box 1 Quali Doc: Learning from patients' experiences Method: A step-by-step process is used to build up a model encompassing 4 dimensions: (1) patients' experiences with care and cure, (2) staff satisfaction including a self-assessment and burnout signs, (3) clinical outcomes, and (4) financial performance. To underpin continuous improvement “Quali Doc” measures an organisations' current performance with a standardised European EuroPEP instrument against self-perceived performance and against a model which represents a position of 'excellence'. Results: The first two dimensions have been developed at now. Results are deployed as performance profiles monitored over time in comparison with standardised benchmarks of a reference group of providers that can be chosen accordingly. Standardised “outreach visits” to the evaluated practices by trained peers were introduced for feedback of data, allowing weighting of results, setting priorities and implementing change. The “Quali Doc” methodology enables providers learning and measuring from each patient using the information gleaned to test improvements.

Integration requires a continuous process

Formal CME and QI initiatives share common aims and require full integration in a continuous process rather than a series of sporadic projects. In order to be an effective tool for change, this process should be a routine part of clinical practice, ideally instilling lasting professional pride and drive toward improvement in each participant in the endeavour.

Continuing education should be based on the learners daily work practices

The use of learners experience can be a powerful tool in CPD. Experience can be used in an intuitive way using case discussions, or in a more formal way by using data from medical records e.g. in discussions on prescription behaviour.

The goals are set by the GP or the practice

Planning professional development can start from perceived needs in individual practices; the goals are set by the physician or the practice team setting up a personal or practice professional development plan. All members of the Primary Health Care team should work together. Quality assurance offers various methods to detect, define and analyse these needs.

Refocus CPD on the local professional environment

There is a need to refocus CPD on the local professional environment as the proper main arena for QI and formal CME. QI should be combined with current local CME systems.

In Quality Improvement Initiatives the place for formal CME should be defined and linked

Definitions of QI initiatives should include precise needs for formal CME and vice versa. Quality Initiatives should be organised in close relationship with formal CME programmes. Audit programmes could be used to define the educational needs for a CME programme (Box 2).

Box 2 The APO method Method: The Audit (A) Project (P) Odense (O) methodology combines prospective data collection with peer review group discussion and presentation and discussion of guidelines in CME sessions. Evaluation and registration of changes. The APO method is an integrated quality development method which follows the audit cycle, suitable for elucidating frequently occurring topics encountered by staff in the primary health care sector. An audit according to the APO method includes: Prospective registration on a specially developed chart suitable for collection of data to study own practice. Follow-up activities including analysis of the registration result, identification of quality problems and subsequent training courses with a view to quality improvement. Final registration and evaluation 1-2 years after the first registration in order to see whether the project target has been achieved. As familiarity with the method increased, it was further developed to enhance the power to implement change. Tailored intensive CME activity has been integrated, and on a further stage APO registrations are combined with other data sources like administrative registers. Patient views will be considered via a questionnaire. Results: The Project is well consolidated in Denmark and is now a resource centre for quality development and postgraduate training in general practice, and also relevant for other personnel groups in the primary health care sector. APO develops and carries out quality development projects, carries out research in quality development methods, and other research based on audit projects. In addition, APO has been involved in the development and implementation of clinical guidelines. Audit work is widespread in all counties in Denmark through a network of specially trained audit supervisors. Similarly, independent audit projects have been established in all the Nordic countries. APO has every year carried out an audit on diagnosis and treatment of infections, in several projects been able to demonstrate a significant reduction in the number of antibiotic prescriptions and a significant change in prescribing pattern towards more small-spectrum antibiotics. In addition, APO has carried out audits on allergy, which has resulted in the issue of national guidelines on the topic, audits on musculoskeletal diseases, where quality problems with regard to X-ray diagnostics and the use of NSAID have been demonstrated. In the last couple of years the APO method has been used at the implementation of the clinical guidelines on prevention of ischaemic heart disease of the Danish College of General Practitioners. More than 2/3 of all Danish general practitioners have once or several times participated in an audit project. APO method is developing in the direction of combining self-registration with a multi-faceted intervention strategy designed to provide the best possibilities of change.