Correspondence

Designing a multifaceted quality improvement intervention in primary care in a country where general practice is seeking recognition: the case of Cyprus

George A Samoutis^1,2 , Elpidoforos S Soteriades^2,3 , Henri E Stoffers⁴ , Theodora Zachariadou¹ , Anastasios Philalithis⁵ and Christos Lionis¹

¹  Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece

²  Department of Primary Care, Cyprus Institute of Biomedical Sciences (CIBS), Nicosia, Cyprus

³  Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, Harvard School of Public Health, MA, USA

⁴  Department of General Practice, School of Primary Care and Public Health (CAPHRI), Maastricht University, Maastricht, The Netherlands

⁵  Health Planning Unit, School of Medicine, University of Crete, Heraklion, Crete, Greece

author email corresponding author email

BMC Health Services Research 2008, 8:181doi:10.1186/1472-6963-8-181

Published:	27 August 2008

Abstract

Background

Quality Improvement Interventions require significant financial investments, and therefore demand careful consideration in their design in order to maximize potential benefits. In this correspondence we present the methodological approach of a multifaceted quality improvement intervention aiming to improve quality of care in primary care, properly tailored for a country such as Cyprus where general practice is currently seeking recognition.

Methods

Our methodological approach was focused on the design of an open label, community-based intervention controlled trial using all patients from two urban and two rural public primary care centers diagnosed with hypertension and type II diabetes mellitus. The design of our intervention was grounded on a strong theoretical framework that included the Unified Theory of Acceptance and Use of Technology, and the Chronic Care Model, which synthesize evidence-based system changes in accordance with the Theory of Planned Behavior and the Theory of Reasoned Action. The primary outcome measure was improvement in the quality of care for two chronic diseases evaluated through specific clinical indicators, as well as the patient satisfaction assessed by the EUROPEP questionnaire and additional personal interviews.

Results

We designed a multifaceted quality improvement intervention model, supported by a varying degree of scientific evidence, tailored to local needs and specific country characteristics. Overall, the main components of the intervention were the development and adoption of an electronic medical record and the introduction of clinical guidelines for the management of the targeted chronic diseases facilitated by the necessary model of organizational changes.

Conclusion

Health planners and policy makers need to be aware of the potential use of certain theoretical models and applied methodology as well as inexpensive tools that may be suitably tailored to the local needs, in order to effectively design quality improvement interventions in primary care settings.