Headache service quality evaluation: implementation of quality indicators in primary care in Europe
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10316/104866 https://doi.org/10.1186/s10194-021-01236-4 |
Resumo: | Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. Methods: We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. Results: The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. Conclusions: The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality. |
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Headache service quality evaluation: implementation of quality indicators in primary care in EuropeHeadache disordersHeadache carePrimary careService quality evaluationQuality indicatorsGlobal campaign against headacheEuropeGermanyHeadacheHumansPrimary Health CareTurkeyQuality Indicators, Health CareQuality of LifeLifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. Methods: We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. Results: The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. Conclusions: The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality.Springer Nature2021-04-28info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/104866http://hdl.handle.net/10316/104866https://doi.org/10.1186/s10194-021-01236-4eng1129-23691129-2377Lenz, B.Katsarava, Z.Gil-Gouveia, R.Karelis, G.Kaynarkaya, B.Meksa, L.Oliveira, E.Palavra, F.Rosendo, InêsSahin, M.Silva, BeatrizUludüz, D.Ural, Y. Z.Varsberga-Apsite, I.Zengin, S. T.Zvaune, L.Steiner, T. J.info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-01-26T21:55:35Zoai:estudogeral.uc.pt:10316/104866Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:21:30.174373Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe |
title |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe |
spellingShingle |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe Lenz, B. Headache disorders Headache care Primary care Service quality evaluation Quality indicators Global campaign against headache Europe Germany Headache Humans Primary Health Care Turkey Quality Indicators, Health Care Quality of Life |
title_short |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe |
title_full |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe |
title_fullStr |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe |
title_full_unstemmed |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe |
title_sort |
Headache service quality evaluation: implementation of quality indicators in primary care in Europe |
author |
Lenz, B. |
author_facet |
Lenz, B. Katsarava, Z. Gil-Gouveia, R. Karelis, G. Kaynarkaya, B. Meksa, L. Oliveira, E. Palavra, F. Rosendo, Inês Sahin, M. Silva, Beatriz Uludüz, D. Ural, Y. Z. Varsberga-Apsite, I. Zengin, S. T. Zvaune, L. Steiner, T. J. |
author_role |
author |
author2 |
Katsarava, Z. Gil-Gouveia, R. Karelis, G. Kaynarkaya, B. Meksa, L. Oliveira, E. Palavra, F. Rosendo, Inês Sahin, M. Silva, Beatriz Uludüz, D. Ural, Y. Z. Varsberga-Apsite, I. Zengin, S. T. Zvaune, L. Steiner, T. J. |
author2_role |
author author author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Lenz, B. Katsarava, Z. Gil-Gouveia, R. Karelis, G. Kaynarkaya, B. Meksa, L. Oliveira, E. Palavra, F. Rosendo, Inês Sahin, M. Silva, Beatriz Uludüz, D. Ural, Y. Z. Varsberga-Apsite, I. Zengin, S. T. Zvaune, L. Steiner, T. J. |
dc.subject.por.fl_str_mv |
Headache disorders Headache care Primary care Service quality evaluation Quality indicators Global campaign against headache Europe Germany Headache Humans Primary Health Care Turkey Quality Indicators, Health Care Quality of Life |
topic |
Headache disorders Headache care Primary care Service quality evaluation Quality indicators Global campaign against headache Europe Germany Headache Humans Primary Health Care Turkey Quality Indicators, Health Care Quality of Life |
description |
Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. Methods: We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. Results: The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. Conclusions: The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-04-28 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10316/104866 http://hdl.handle.net/10316/104866 https://doi.org/10.1186/s10194-021-01236-4 |
url |
http://hdl.handle.net/10316/104866 https://doi.org/10.1186/s10194-021-01236-4 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
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1129-2369 1129-2377 |
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info:eu-repo/semantics/openAccess |
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openAccess |
dc.publisher.none.fl_str_mv |
Springer Nature |
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Springer Nature |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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