Open Access Research article

Can we import quality tools? a feasibility study of European practice assessment in a country with less organised general practice

Roy Remmen1*, Luc Seuntjens1, Dominique Paulus2, Dominique Pestiaux3, Klaus Knops4 and Ann Van den Bruel2

Author Affiliations

1 Department of General Practice, Geriatrics and Interdisciplinary care, Faculty of Medicine, University of Antwerp, Antwerp, Belgium

2 Belgian Health Care Knowledge Centre, Brussels, Belgium

3 Department of General Practice, Université Catholique de Louvain, Brussels, Belgium

4 Department of General Practice, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium

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BMC Health Services Research 2009, 9:183  doi:10.1186/1472-6963-9-183

Published: 11 October 2009



Quality is on the agenda of European general practice (GP). European researchers have, in collaboration, developed tools to assess quality of GPs. In this feasibility study, we tested the European Practice Assessment (EPA) in a one-off project in Belgium, where general practice has a low level of GP organisation.


A framework for feasibility analysis included describing the recruiting of participants, a brief telephone study survey among non-responders, organisational and logistic problems. Using field notes and focus groups, we studied the participants' opinions.


In this study, only 36 of 1000 invited practices agreed to participate. Co-ordination, administrative work, practice visits and organisational problems required several days per practice. The researchers further encountered technical problems, for instance when entering the data and uploading to the web-based server. In subsequent qualitative analysis using two focus groups, most participant GPs expressed a positive feeling after the EPA procedure. In the short period of follow-up, only a few GPs reported improvements after the visit. The participant GPs suggested that follow-up and coaching would probably facilitate the implementation of changes.


This feasibility study shows that prior interest in EPA is low in the GP community. We encountered a number of logistic and organisational problems. It proved attractive to participants, but it can be augmented by coaching of participants in more than a one-off project to identify and achieve targets for quality improvement. In the absence of commitment of the government, a network of universities and one scientific organisation will offer EPA as a service to training practices.