Is the quality of care in general medical practice improving? Results of a longitudinal observational study

Abstract

Background: The demand for increased accountability within health care has led to a myriad of government initiatives in the United Kingdom, with the aim of improving care, setting minimum standards, and addressing poor performance.

Aim: To assess the quality of care in English general practice in the year 2001 compared with 1998, in terms of access, interpersonal care, and clinical care (chronic disease management, elderly care, and mental health care).

Design of study: Observational study in a purposive sample of general practices in England.

Setting: Twenty-three general practices in England--eight in North Thames, seven in the North West, and eight in the South West.

Results: Outcome measures were: quality of chronic disease management (angina, adult asthma and type 2 diabetes from practice questionnaires and medical record review), elderly care and mental health care (from practice questionnaires), access to care, continuity of care and interpersonal care (from practice and patient questionnaires) and costs (mean change in practice budget between 1998 and 2001). There were significant improvements in quality of care in terms of organisational access to services (P = 0.016), practice organisation of chronic disease management (P = 0.039), and the quality of angina care (P = 0.003). There were no significant changes in quality scores for mental health care, elderly care, access and interpersonal care. The mean practice budget rose by 3.4% between 1998 and 2001 (adjusted for inflation).

Conclusion: These findings provide evidence of improvements in some aspects of the quality of care, achieved at modest cost. This was achieved during a time when the National Health Service was undergoing a series of reforms. However, primary care in England is characterised by variation in care, with significant improvements still possible.